Carcinoembryonic antigen (CEA) determinations performed in the milk of a nursing mother with an inoperable breast cancer revealed a 10-15-fold higher level compared with CEA levels in the milk of healthy nursing women. CEA was highly elevated in the milk of the tumor-bearing breast (1100 ? 100 ng/ml) and moderately elevated in the milk of the clinically nonaffected breast (700 ? 50 ng/ml). However, serum CEA levels were within normal range (9.8 ? 0.5 ng/ml). The various theoretical and practical implications of this finding, including considerations for early breast cancer detection, are discussed.Cancer Case ReportA 44-year-old Arabic woman, mother of 13 children and living in a small village, noticed a mass in her left breast during pregnancy. She did not ask for medical advice then and gave birth to a normal baby. Shortly thereafter she became pregnant again and during this pregnancy she noticed the breast mass had grown, causing local irritation. Again she delivered a normal baby, but it was only eight months later, while still nursing her child. that she was first examined by a physician. A huge inoperable mass was palpated in her left breast: it caused nipple retraction and infiltrated the skin above. Enlarged lymph nodes were found in the left supraclavicular fossa and in the left axilla. No definite mass could be palpated in the right breast. The rest of the physical examination was normal. A biopsy of the left breast mass showed a poorly differentiated ductal carcinoma of infiltrative nature. Blood chemistry tests, gastrointestinal tract, chest radiograms, and bone and liver scans were within normal limits. The patient started hormonal treatment by testosterone injections, radiological castration, and thereafter two courses of combination chemotherapy consisting of Cytoxan, methotrexate, and 5-fluorouracil (CMF). Following therapy, marked improvement was noticed with partial regression of the tumor and lymph nodes. Prior to radiotherapy, serum and milk from both breasts was taken to determine CEA levels. CEA was measured by radioimmunoassay with a commercial kit ("CEA Ire Sorin," Commissariat a 1'Energie Atomique GIF-Sur Yvette, France). Normal serum CEA values in our laboratory went up to 15 ngirnl. To our surprise, the milk from the left breast revealed a high CEA level of 1100 :t 100 ngiml; in the right breast it was moderately elevated to 700 ? 50 ngirnl. The serum CEA level, however, was 9.8 2 0.5 ng/ml. The mean and S . D . of CEA levels in milk of 43 healthy nursing women, 2-20 days postpartum, were 66.4 t 55.6 ndml (range of 5.0-252.0 ngiml). Following radiotherapy, the milk stopped flowing. DiscussionT h e only study concerning CEA determination in milk was that of Pusztaszri and Mach," who reported a CEA level of 150 ngiml in the colostrum of only one out of five women, five days postpartum, by a double diffusion method. To the best of our knowledge no other study of CEA levels, either in normal milk o r

Forty-five patients with locally advanced breast carcinoma were treated by radiotherapy. Twelve of them became operable and were operated. After 3 and 4 years in comparable clinical stage the rate of metastases in the nonoperated group was 78.6% and in the operated 75%. The survival after 3 and 4 years in comparable clinical stages was similar. In more advanced stages the survival was worse. Considering the trauma of mastectomy and the similar survival obtained in our material, an international trial should be performed to decide whether inoperable breast cancer becoming operable after radiotherapy should be operated.